After seeing Geebsie's pic in R&R(in which you look like hammered shit after working 90+ hrs), I was reminded that I still don't understand the logic in working med students/interns/residents to fucking death.
How is this effective training or most beneficial to the patient? Not that I'm naive enough to think that hospital administrators have patient welfare as their top priority, but surely this constant medical personnel fatigue has caused deaths and lawsuits?
The first question I'd ask any ER doc is "How long have you been on?" and I really shouldn't have to.
Explain.
Geebs, Saturn
To hear my girlfriend describe it, students do rotations and residencies because it is the best teaching method, and that means even if they're not interested in ER, they still have to do some of it to get a feel for everything involved in medicine.
And if you're an ER doc or a surgeon or something like that, long and odd hours will become your life, so you'd better get used to it early.
My gf is planning to do OB/GYN, so she'll probably have a lot of days where she'll be called in at 2 am and have to stay on for 12 hours. I suppose making the students do it helps weed out those who aren't cut out for it...
And if you're an ER doc or a surgeon or something like that, long and odd hours will become your life, so you'd better get used to it early.
My gf is planning to do OB/GYN, so she'll probably have a lot of days where she'll be called in at 2 am and have to stay on for 12 hours. I suppose making the students do it helps weed out those who aren't cut out for it...
The only way to learn is to get stuck in. When it comes down to it, stuff you got out of textbooks does more harm than good, as you end up trying to fit patients to weird syndromes when they've just got a cold or something. Plus it's impossible to remember management unless you've got a patient in front of you, especially when you're just beginning your clinical career. Exposure to lots of patients is the entire reason why we're willing to work these hours.
Totally fucks up your sex life, though.
Totally fucks up your sex life, though.
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blood.angel
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Nightshade
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OK, I can certainly agree with the diving in headfirst bit, but that doesn't explain the training model. Seems to me that a horribly fatigued resident is a disaster waiting to happen.Geebs wrote:The only way to learn is to get stuck in. When it comes down to it, stuff you got out of textbooks does more harm than good, as you end up trying to fit patients to weird syndromes when they've just got a cold or something. Plus it's impossible to remember management unless you've got a patient in front of you, especially when you're just beginning your clinical career. Exposure to lots of patients is the entire reason why we're willing to work these hours.
Totally fucks up your sex life, though.
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blood.angel
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Why do they fatigue recruits in bootcamp?Nightshade wrote:OK, I can certainly agree with the diving in headfirst bit, but that doesn't explain the training model. Seems to me that a horribly fatigued resident is a disaster waiting to happen.Geebs wrote:The only way to learn is to get stuck in. When it comes down to it, stuff you got out of textbooks does more harm than good, as you end up trying to fit patients to weird syndromes when they've just got a cold or something. Plus it's impossible to remember management unless you've got a patient in front of you, especially when you're just beginning your clinical career. Exposure to lots of patients is the entire reason why we're willing to work these hours.
Totally fucks up your sex life, though.
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Nightshade
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The reasons for that are twofold: 1.) To get you used to operating under an approximation of the level of tiredness you'd get in a combat environment and 2.) To make you more prone to instantly doing what you're told.
Neither of these things are desirable in doctors, imho. I can see that the first case is applicable to the medical field, but only where there's a shortage of trained staff. It seems to skirt the issue without really answering the question.
Neither of these things are desirable in doctors, imho. I can see that the first case is applicable to the medical field, but only where there's a shortage of trained staff. It seems to skirt the issue without really answering the question.
Nightshade[no u]
Reason #1 doesn't have to be only in the case where staffing is short. In most cases, the doctor who treats you is the one you go to for answers when you need them. If you need them at 2am, then that doctor had better be competent at that time. The director of the clinic where I work gives all his patients his pager and cell phone numbers so they can call him personally if they have questions about meds, etc, because he's the one personally responsible for their treatment.
The same goes for OB/GYN: the doctor you see at the beginning of your pregancy is the same one who follows you to term and delivers the baby. So if you go into labor at 2am, they'd better be able to go to the hospital and perform properly.
The same goes for OB/GYN: the doctor you see at the beginning of your pregancy is the same one who follows you to term and delivers the baby. So if you go into labor at 2am, they'd better be able to go to the hospital and perform properly.
That kind of fits into the the "doctor can't let go of his work" category actually, which I also have and which I think is a bit pathological.
I agree with NS in that excessively long hours are dangerous, but as long as you're busy the whole time it's generally OK. The two situations in which I get really out of it are when I've had an inadvertent break of a couple of hours because nothing was happening, or when my relief's a couple of hours late and I have to keep working (for no money
) until someone shows up
I agree with NS in that excessively long hours are dangerous, but as long as you're busy the whole time it's generally OK. The two situations in which I get really out of it are when I've had an inadvertent break of a couple of hours because nothing was happening, or when my relief's a couple of hours late and I have to keep working (for no money
) until someone shows upI was doing medical research on the PhD level for awhile (but I didn't have to deal with patients, just rats and cells). That entailed 60+ hours a week in the research lab plus a full load of graduate coursework in molecular biology, biochemistry, protein biotechnology, and immunology.
I drank. A lot.
I drank. A lot.
becoming a good doctor requires more than textbook wisdom, like geebs said, you need to see a lot of patients, gain plentiful experience before you can make rightful decisions later. Ah well, depends on what you're gonna specialize in.
I'm doing 5x16 hours shifts this week, from 4 pm till 8am in (anesthesiology). But nothing happened this night, no reanimation, no emergency operations, no transplantations, so I could sleep 6+ hours Only doing 5 shifts this week for my internship, after that it's 3 weeks of intensive care....so lots of coffee drinking.
Starting in 6 hours again
I'm doing 5x16 hours shifts this week, from 4 pm till 8am in (anesthesiology). But nothing happened this night, no reanimation, no emergency operations, no transplantations, so I could sleep 6+ hours
Only doing 5 shifts this week for my internship, after that it's 3 weeks of intensive care....so lots of coffee drinking. Starting in 6 hours again
that might be the case if you are the private doctor of the patient, you can't always be therewerldhed wrote:Reason #1 doesn't have to be only in the case where staffing is short. In most cases, the doctor who treats you is the one you go to for answers when you need them. If you need them at 2am, then that doctor had better be competent at that time. The director of the clinic where I work gives all his patients his pager and cell phone numbers so they can call him personally if they have questions about meds, etc, because he's the one personally responsible for their treatment.
The same goes for OB/GYN: the doctor you see at the beginning of your pregancy is the same one who follows you to term and delivers the baby. So if you go into labor at 2am, they'd better be able to go to the hospital and perform properly.
btw, this is a nice read on what it requires to become a doctor: http://people.howstuffworks.com/becoming-a-doctor.htm
It's focused on the american situation, but it generally applies to everywhere when it comes to longevity of the study/specialisation.
It's focused on the american situation, but it generally applies to everywhere when it comes to longevity of the study/specialisation.
They mainly use cocaine in ENT (KNO) surgery. I heard it's different than from the street, less potent maybe. The hospital pharmacy controls the supply btwRyoki wrote:They've got some excellent medicinal cocaine in hospitals which they use for eye surgery. The whole working med students to death thing is just a scheme to get more clients by the head anesthesiologist, who controls the supply.
Bloody hell, and I thought my hours were silly. Still, the anaesthetics night shift is supposed (yeah I know it never really works out like that) to be reasonably quiet 'cos it's only emergency stuff, no lists.saturn wrote:I'm doing 5x16 hours shifts this week, from 4 pm till 8am in (anesthesiology). But nothing happened this night, no reanimation, no emergency operations, no transplantations, so I could sleep 6+ hours
Starting in 6 hours again
It must be nice being in anaesthetics though, you get to spend lots of time with one patient with whom you don't have to bother making any conversation, and all you have to do at resuscitations is squeeze the bag and gently remind the medical registrar that the patient's brain has, by now, turned into soup.
Speaking of which, we've finally got the new defibrillators where the pads are stuck to the patient and all you have to do is stand back and press the button. It's so nice not to get zapped the whole time for a change
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Massive Quasars
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Doctors should be medicated so they can be kept awake and alert for an extended period of time.
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Geebs wrote:Bloody hell, and I thought my hours were silly. Still, the anaesthetics night shift is supposed (yeah I know it never really works out like that) to be reasonably quiet 'cos it's only emergency stuff, no lists.saturn wrote:I'm doing 5x16 hours shifts this week, from 4 pm till 8am in (anesthesiology). But nothing happened this night, no reanimation, no emergency operations, no transplantations, so I could sleep 6+ hours
Starting in 6 hours again
It must be nice being in anaesthetics though, you get to spend lots of time with one patient with whom you don't have to bother making any conversation, and all you have to do at resuscitations is squeeze the bag and gently remind the medical registrar that the patient's brain has, by now, turned into soup.
Speaking of which, we've finally got the new defibrillators where the pads are stuck to the patient and all you have to do is stand back and press the button. It's so nice not to get zapped the whole time for a change
It's ok, cause the shifts are not fixed. I can skip one if I haven't slept enough (like last night). Last night was crazy, a few reanimations, traumas, an emergency-trepanation of an intracerebral hematoma, intubation of an COPD patient, central lines. I slept one hour and didn't hear the peeper, but someone slammed on my door and I was running groggy to the chaotic ER room.
The trepanation was crazy, after the tension dropped a few times from 270 systolic to 35, the patient got atrial fibrilliation and almost no output. We had to do CPR 2 times, but the patient was lying on the belly with head fixed. Looked crazy. And we had to zap her with those pads, increasing the adrenaline/dobutamine pumps. When the neuro-surgeon was closing her head we were basically resuscitating her chemically with adrenaline. The family was called in cause she would die if we turned off the pumps and lifesupport.
To my big surprise this morning, when we were checking her on the intensive care, she was doing great without lifesupport nor any drugs. Sedated, but great cardiac output. Crazy.